1. A Route Map using Theory of Change:
Understanding the impact of
the Living With and Beyond Cancer model
for people affected by cancer
Macmillan Cancer Support in partnership with…
Richard Metcalfe - Programme Lead
Hayley Williams - Clinical Pathway Manager
Sarah Allen - Macmillan Evidence Officer

2. WiFi name: WifiLoveMCR Password: internet Join the conversation on Twitter using #DrivingChange

3. Phase 3 Programme aim
Risk stratification
Care pathway based on individual needs
Identification of options for complex, shared and self-care pathways
Recovery Package
Holistic Needs Assessment
Treatment summary
Cancer Care review
Education and support
Supported Self-management
Enable understanding and management of the consequences of treatment
Promoting healthy lifestyles and well-being
Sign-posting to other services/support
Diagnosis
“to enable every adult living with breast, colorectal or prostate cancer in each of the eight CCG areas to have access to the LWABC model of care from diagnosis onwards by 2020”

4. How we work together and make decisions
Importance of
getting the right people around the table
working with commissioners

5. Programme priorities Clinical Engagement model
Risk stratification in 3 ‘Clinical Delivery Groups’ 150 clinicians & managers
Lead CNS group
e-HNA/treatment summary and PROMS (x5 acute trusts)
Programme Evaluation – testing theories of change, what is the impact so what? evidence of the RP as a coherent package?
Communications and engagement strategy
Engagement with People affected by cancer ……

6. Utilising localities intelligence and what we already know from the CPES, regional and local engagement work
Principles for engagement with people affected by cancer – consulted with the public during summer 2016
Building on co-production experience and skills across the footprint ave. 60 people affected by cancer per locality involved in co-designing solutions
Specific work via the voluntary and community sector organisations to engage reach/seldom heard groups
Using intelligence from conversations with people affected by cancer to inform a decision making framework
Development of an Advisory board of people affected by cancer – representative of the localities to support decision making
Continued involvement of PABC in recruitment

7. Themes from across our localities
Lots of great work, staff and services out there
Having ‘Conversations’, tools and validation:
person centred conversations with a meaningful shared care plan … the elements of the LWABC model (e.g.: HNA, Treatment summary, Cancer Care review) are tools/enablers
Importance of community access, co-ordination and linking PABC to support (navigation)
Need for diverse access and delivery options e.g.: support, physical activity and information
It’s not just about specialist cancer services
Risk stratification
Cancer Care Reviews – what/how/quality?
Models of care around GP practices; local communities/neighbourhoods (primary care strategy)
Workforce development: culture, training, roles
All tumour sites/x3 tumour sites programme

8. Locality approach test projects
LWABC model Programme priorities
eHNA/
treatment summary/PROMS (Barnsley)
‘Opt out’ acute to community model, whole ‘system’ (Doncaster & Bassetlaw)
Phase 1 CSW roles, Education, H&WB, ‘Universal door’. Phase 2 Community (Rotherham)
Phase 1 Community; CCR, Education & Expert Pts.
Phase 2 CSW roles
(N Derbyshire & Hardwick)
Existing support services testing the use of PAM as a whole ‘system‘ (Sheffield)

9. what it is and how to use it
Theory of change
what it is and how to use it

10. Key messages – theory of change
It aims to provide clarity about what we think a programme will achieve and how (emphasis on causality and explicit assumptions)
It enables stronger programme design, monitoring and evaluation.
It should be revised over time as programmes evolve and evidence becomes available
It should ideally be developed at design stage but adds value at any stage of the programme cycle

11. Definition: theory of change
Theory of change: A detailed description of how and why we expect change to happen in a given context, making explicit our assumptions and understanding of causality.
Programme Theory
Driver diagram
Logic model
Impact chain
Terms often used interchangeably – but theory of change usually broader picture, emphasises explicit causality and assumptions . Focus tends to be whole system change /multi-stakeholder with programme specific focus identified within it. We can use a logic model type format to summarise it...
NB – other stakeholders may use different terminology for similar concept – eg NHS – ‘Benefits realisation plan , driver diagram’

12. Why do a theory of change?
How?
Change happens
Three mistakes in M&E:
Only focussing on outputs (how many meetings, how many publications)
Only focussing on impacts (decrease in infant mortality, new legislation, access to water, incidence of malaria)
Assuming a causal link between the two
Why?
For whom?

13. A theory of change and spheres of control, influence and interest
NB Changed the definitions here!!! Tbc
Note diminishing control the higher up the chain
We are primarily interested in outcomes – and in the extent to which a project has contributed to the change
NB Change not linear – we don’t necessarily achieve what we hope (NB assumptions) - may contribute to unexpected outcomes (+/-) – underlines need to monitor outcomes – not just evaluate at end of programme.
Definitions: NB Outcomes sometimes called Benefits – eg see PMO templates

14. In simplest terms Impact Changes Outcomes
Outputs
Inputs
Actions

15. HNA theory of change – LWABC SYorks Draft (Feb ‘17)
Reduction in unplanned service use
HNA theory of change – LWABC SYorks Draft (Feb ‘17)
Improved communication between secondary and primary/community and patients and carers
If patients have the ability to self- manage
If patients choose not to use services
Patients access non- clinical (holistic) support
PLWC have reduced anxiety, improved confidence
Greater facility to self-manage
Patients’ acceptance of the referral
Primary/communi ty providers think care plan is appropriate, agree with referrals
Assuming non- clinical support available across footprint
If services are accessible (distance-cost etc)
If service providers have capacity
PLWC have opportunity to voice concerns and better meet them
PLWC have greater understanding of support available
Patient has personal record to reflect back on
Care plans actioned (referrals to holistic support)
Care plans shared with patients, primary and community services
Changes (outcomes)
HNA
And referrers think they have quality services
Professionals have time to make referrals and are aware of services
Meaningful care plan
Actions (outputs)
If care plan well written
(HNA) Person- centred conversation at appropriate moment(s)
Assumptions
Training – around process/conversation, receptivity/system readiness
Pre-conditions (T2)
Agreed, validated tool
And… ?

16. How change really happens
Impact
OUTCOME
OUTCOME
OUTCOME
OUTPUT
OUTCOME
ACTIVITY
ACTIVITY
OUTCOME
ACTIVITY
OUTCOME
OUTCOME
OUTPUT
OUTCOME
Plan
INPUTS
ACTIVITY
OUTPUT
OUTPUT
ACTIVITY
INPUTS
OUTCOME
ACTIVITY
ACTIVITY
OUTCOME
INPUTS
OUTPUT
INPUTS
ACTIVITY
INPUTS
Time
Source: Ricardo Wilson-Grau (inspired by Jeff Conklin)

17. 3 minute theory of change
Statement one: ‘We/programme will……(describe what will be done – where, with whom, how – i.e. actions/outputs)
Statement two: ‘This will result in…..(direct changes – e.g. changes in knowledge, behaviour, capacity, access to and quality of services i.e. outcomes)
Statement three: ‘Which will contribute to…( higher level, longer- term changes – e.g. health status, system savings i.e. impact)
The simplest version of a theory of change – essentially a brief description - and a good exercise to do with a team to be explicit and ensure a shared understanding about what they want to do and how.
This can then be developed further – by adding assumptions – and then developing into a more detailed theory of change.

18. 3 minute theory of change Example 1: My Party
I will….buy food and drink, send out invitations, tidy up my house, pick out music (activities-outputs)
This will result in …..my friends coming to my party, eating, drinking and dancing (outcomes – changes in behaviour)
And will contribute to….. them having a good weekend (impact – wider change to their well-being)
Note the assumptions involved at each level (assume it is a convenient time for a party, music that people like, no other major negative events affecting peoples’ weekends…) In a programme these assumptions need to be made explicit and included in the action plan if necessary (eg research, preparation, mitigation actions) and the monitoring and evaluation framework.

19. Richard Metcalfe – richard.metcalfe1@nhs.net
Hayley Williams -
Sarah Allen -